Operative surgery . of a circular valvelike structurenear the surface, which readily permits of the introduction of food, yet aimsto prevent the escape of fluid at all times. The Operation.— ?Make the abdominal incision at the most desirable situ-ation irrespective of the muscular structures, as their action is not needed inthis method ; grasp the anterior surface of the stomach near the greatercurvature with the fingers or a suitable forceps, and draw a cone-shaped])ortion well ujnvard into the opening, giving it in charge of an assistant;introduce, so as to include the serous and muscular co
Operative surgery . of a circular valvelike structurenear the surface, which readily permits of the introduction of food, yet aimsto prevent the escape of fluid at all times. The Operation.— ?Make the abdominal incision at the most desirable situ-ation irrespective of the muscular structures, as their action is not needed inthis method ; grasp the anterior surface of the stomach near the greatercurvature with the fingers or a suitable forceps, and draw a cone-shaped])ortion well ujnvard into the opening, giving it in charge of an assistant;introduce, so as to include the serous and muscular coats of the stomach, 150 OPERATIVE SURGERY. two and a lialf inches below the apex of the cone, two purse-string snturesof chroniicized catgut (Fig. 953); draw them tightly, thus forming a neck(Fig. 954); raise up a portion of the gastrocolic omentum and suture it ina culflike manner around the constriction with silk (Fig. 955); suture the stomach in place with silk so as to in-clude its serous and muscular coats,. Fig. 953. Fig. 954. Fig. 953.—Senns method of gastrostomy, the purse-string sutures 954.—Senns method of gastrostomy, the purse-string sutures drawn tiglit. the upper portion of the omental cuff, and all of the structures of the bor-ders of the abdominal wound except the skin; close the skin with silkworm-gut sutures, leaving in sight the apex of the cone from which the valve isformed; make an incision at once, or later, as need be, about an inch and ahalf in length in the center of the exposed portion, and introduce through ita rubber tube into the stomach; invert the lips of the incision, and unitewith eacli other the corresponding borders with silkworm gut in such a man-ner as to form a valvelike opening not more than half an inch in length(Fig. 956). The tube is employed only at the time of feeding. This method
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